Individual
KIMBERLY MATTISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2501 HUNTER PL STE 101, WOODBRIDGE, VA 22192-3940
(540) 720-2261
Mailing address
8301 GO WEST RD NW, ALBUQUERQUE, NM 87120-3785
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
220208371
VA
235Z00000X
Speech-Language Pathologist
Primary
SAH-2024-0120
NM
Other
Enumeration date
01/17/2018
Last updated
08/08/2024
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